Does neoadjuvant chemoradiation downstage esophageal carcinoma?

Research output: Contribution to journalArticle

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Abstract

Background: Neoadjuvant chemoradiotherapy is administered to patients with esophageal carcinoma with the belief that this will both downstage the tumor and improve survival. Endoscopic ultrasound (EUS) is currently the most accurate method of staging esophageal cancer for tumor (T) and lymph node (N) status. Because both EUS and neoadjuvant therapy for esophageal carcinoma are relatively new, there are few data examining the relationship between EUS stage and histological stage (the stage after resection) in patients receiving neoadjuvant therapy. Methods: To determine the effect of neoadjuvant chemoradiotherapy on T and N stage as determined by EUS, we retrospectively compared two groups of patients with esophageal cancer staged by EUS. One group (33 patients) underwent neoadjuvant therapy (Walsh protocol: 5-fluorouracil, cisplatin, and 4000 rads of external beam radiation) followed by resection. The second group (22 patients), a control group, underwent resection without neoadjuvant therapy. We then compared histological stage to determine if there was a downstaging in the patients receiving neoadjuvant therapy. Survival was evaluated as well. Results: EUS accurately predicted histologic stage. In the control group EUS overestimated T stage in 3 of 22 (13%), underestimated N stage in 2 of 22 (9%), and overestimated N stage in 2 of 22 (9%) of patients. Preoperative radiochemotherapy downstaged (preoperative EUS stage versus pathologic specimen) 12 of 33 (36%) of patients whereas only 1 of 22 (5%) of patients in the control group was downstaged. Complete response (no tumor found in the surgical specimen) was observed in 5 of 33 (15%) of patients receiving radiochemotherapy. Survival was prolonged significantly in patients receiving radiochemotherapy: 20.6 months versus 9.6 months for those (stage II or III) patients not receiving radiochemotherapy (P

Original languageEnglish (US)
Pages (from-to)440-444
Number of pages5
JournalAmerican Journal of Surgery
Volume181
Issue number5
DOIs
StatePublished - 2001

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Carcinoma
Chemoradiotherapy
Neoadjuvant Therapy
Esophageal Neoplasms
Control Groups
Survival
Neoplasms
Fluorouracil
Cisplatin
Lymph Nodes
Radiation

Keywords

  • Chemoradiotherapy
  • Esophageal carcinoma

ASJC Scopus subject areas

  • Surgery

Cite this

Does neoadjuvant chemoradiation downstage esophageal carcinoma? / Slater, Matthew; Holland, John; Faigel, Douglas O.; Sheppard, Brett; Deveney, Clifford.

In: American Journal of Surgery, Vol. 181, No. 5, 2001, p. 440-444.

Research output: Contribution to journalArticle

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title = "Does neoadjuvant chemoradiation downstage esophageal carcinoma?",
abstract = "Background: Neoadjuvant chemoradiotherapy is administered to patients with esophageal carcinoma with the belief that this will both downstage the tumor and improve survival. Endoscopic ultrasound (EUS) is currently the most accurate method of staging esophageal cancer for tumor (T) and lymph node (N) status. Because both EUS and neoadjuvant therapy for esophageal carcinoma are relatively new, there are few data examining the relationship between EUS stage and histological stage (the stage after resection) in patients receiving neoadjuvant therapy. Methods: To determine the effect of neoadjuvant chemoradiotherapy on T and N stage as determined by EUS, we retrospectively compared two groups of patients with esophageal cancer staged by EUS. One group (33 patients) underwent neoadjuvant therapy (Walsh protocol: 5-fluorouracil, cisplatin, and 4000 rads of external beam radiation) followed by resection. The second group (22 patients), a control group, underwent resection without neoadjuvant therapy. We then compared histological stage to determine if there was a downstaging in the patients receiving neoadjuvant therapy. Survival was evaluated as well. Results: EUS accurately predicted histologic stage. In the control group EUS overestimated T stage in 3 of 22 (13{\%}), underestimated N stage in 2 of 22 (9{\%}), and overestimated N stage in 2 of 22 (9{\%}) of patients. Preoperative radiochemotherapy downstaged (preoperative EUS stage versus pathologic specimen) 12 of 33 (36{\%}) of patients whereas only 1 of 22 (5{\%}) of patients in the control group was downstaged. Complete response (no tumor found in the surgical specimen) was observed in 5 of 33 (15{\%}) of patients receiving radiochemotherapy. Survival was prolonged significantly in patients receiving radiochemotherapy: 20.6 months versus 9.6 months for those (stage II or III) patients not receiving radiochemotherapy (P",
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